Abstract and Introduction
Abstract
Objective To examine the association of vegetable and fruit consumption with the risk of non-gallstone-related acute pancreatitis.
Design A population-based prospective cohort of 80 019 women and men, aged 46–84 years, completed a food-frequency questionnaire at baseline and was followed up for incidence of non-gallstone-related acute pancreatitis from 1 January 1998 to 31 December 2009. Participants were categorised into quintiles according to consumption of vegetables and consumption of fruit. Cox proportional hazards models were used to estimate RRs and 95% CIs.
Results In total, 320 incident cases (216 men and 104 women) with non-gallstone-related acute pancreatitis were identified during 12 years of follow-up (891 136 person-years). After adjustment for potential confounders, the authors observed a significant inverse linear dose–response association between vegetable consumption and risk of non-gallstone-related acute pancreatitis; every two additional servings per day were associated with 17% risk reduction (RR=0.83; 95% CI 0.70 to 0.98; p=0.03). Among participants consuming >1 drink of alcohol per day and among those with body mass index ≥25 kg/m, the RR for the highest compared with the lowest quintile of vegetable consumption was 0.29 (95% CI 0.13 to 0.67) and 0.49 (95% CI 0.29 to 0.85), respectively. Fruit consumption was not significantly associated with the risk of non-gallstone-related acute pancreatitis; the RR comparing extreme quintiles of consumption was 1.20 (95% CI 0.81 to 1.78).
Conclusions Vegetable consumption, but not fruit consumption, may play a role in the prevention of non-gallstone-related acute pancreatitis.
Introduction
The pathogenesis of acute pancreatitis is not fully elucidated, but the initial step in the development of the disease seems to be an uncontrolled activation of the proteolytic enzyme trypsin in the pancreatic acinar cells. The resulting autodigestion of the pancreas leads to an inflammatory cascade in which reactive species are of major importance. Reactive oxygen and nitrogen species exert damage on the pancreas through direct effects on cellular components and by recruitment of inflammatory cells. In the course of an attack of acute pancreatitis, markers for superoxide dismutase (an endogenous antioxidant enzyme) are increased while levels of antioxidant molecules (eg, vitamin C) are decreased.
Although the role of antioxidants in the clinical management of acute pancreatitis seems to be unclear, an existing imbalance in the antioxidant status due to dietary factors may facilitate development of acute pancreatitis by making the pancreas more sensitive to oxidative stress. Consumption of vegetables and fruit, which are rich in antioxidants, can hypothetically create an optimal redox balance and protect against the development of the disease. The association of vegetables and fruit with the risk of acute pancreatitis has been scarcely investigated. One previous case-control study observed an inverse association between fruit consumption and risk of acute pancreatitis.
Using a large population-based prospective, the cohort of Swedish men (COSM) and women, we aimed to examine the association of vegetable and fruit consumption with the risk of non-gallstone-related acute pancreatitis. Furthermore, we evaluated whether alcohol consumption, overweight and smoking—factors associated with oxidative stress—may modify this association.